1 Scenarios modelled and key questions

1 Scenarios modelled and key questions

The aim of this report is to estimate the differential cost effectiveness of continuing to offer Healthy Start vitamins to the current target audience, compared with offering them on a 'universal' basis (see below). This report does not aim to determine the cost effectiveness of the current scheme.

The report considers 2 universal scenarios.

Scenario 1

Healthy Start vitamins are offered to the following groups (as happens now) but regardless of people's income level or entitlement to qualifying benefits:

  • all pregnant women (from 10 weeks)

  • women with a child aged under 12 months

  • children over 6 months and under 4 years.

Scenario 2

Healthy Start vitamins are offered to the following groups, regardless of income level or entitlement to qualifying benefits:

  • women planning a pregnancy

  • pregnant women

  • women with a child aged under 12 months

  • infants aged from 0–6 months

  • children aged from 6 months to 5 years.

In this scenario, Healthy Start vitamins are offered to various groups not included in the current scheme. This reflects:

  • UK dietary recommendations that advise women planning a pregnancy and those in the first 12 weeks of pregnancy to take a daily 400 microgram folic acid supplement.

  • The 2012 UK Chief Medical Officers' recommendation that all pregnant and breastfeeding women, and infants and young children aged from 6 months to 5 years, take a daily supplement of vitamin D (Vitamin D – advice on supplements for at risk groups Department of Health).

  • SACN's 2007 recommendations that breastfed babies whose mothers have not taken vitamin D supplements during pregnancy should be given vitamin D supplements. SACN also recommended that formula‑fed infants who may be receiving less than 500 ml of infant formula daily are given vitamin D supplements (SACN update on vitamin D – 2007 Public Health England).

Key and subsidiary questions

The following key question was asked:

  • Would it be cost effective to move the Healthy Start vitamin programme from the current targeted offering to a universal offering, according to the 2 scenarios defined above?

The subsidiary questions were:

1. Is universal provision of Healthy Start supplements to women seeking to become pregnant cost effective, compared with no provision under Healthy Start?[3]

2. Is universal provision of Healthy Start supplements to women who are less than 10 weeks pregnant cost effective, compared with no provision under Healthy Start?

3. Is universal provision of Healthy Start supplements for infants aged 0 to 6 months cost effective, compared with no provision under Healthy Start?

4. Is universal provision of Healthy Start supplements for children aged 4 to 5 years cost effective, compared with no provision under Healthy Start?

5. Would universal provision of supplements create a 'spill over' effect, by increasing uptake in the current target group? Would this be cost effective compared with the current targeted offering?

6. What is the incremental cost‑effectiveness ratio (ICER) of extending the eligibility for universally available vitamins to:

  • infants from birth to 6 months, compared with providing them for those aged over 6 months

  • children between their 4th and 5th birthday, compared with providing them until their 4th birthday

  • women less than 10 weeks pregnant, compared with providing them to those over 10 weeks pregnant (the current target)

  • women intending to become pregnant?



[3] Note: the findings of the modelling exercise are reported for 'women planning a pregnancy and women less than 10 weeks pregnant'. This is because the only available data on the risk of having a pregnancy affected by a neural tube defect for women planning a pregnancy included those in the first trimester of pregnancy. In addition, it was thought unlikely that supplements would be offered to women before conceiving and from the 10th week of pregnancy onwards and not to women in the first 10 weeks of pregnancy.